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Family Medicine Cases > Knee Pain > Flashcards

Knee Pain Flashcards

(45 cards)

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1
Q

Common knee conditions in children

A 
Patellar subluxation
Tibial apophysitis (Osgood-Schlatter)
Patellar tendonitis
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2
Q

Common knee conditions for adults

A 
Patellofemoral syndrome
- Dx of exclusion for anterior knee pain
Overuse syndromes
Trauma 
Inflammatory arthropaties
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3
Q

Hx of trauma

A

Increased risk of injury to ligaments and meniscal tears

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4
Q

Impair ability to squat

A

Effusion
Arthritis
Ligament damage

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5
Q

Ability to duck waddle

A

Rules out

  • ligament instability
  • Effusion
  • Significant damage to meniscal cartilage
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6
Q

Work-up for septic arthritis

A 
CBC w/ differential
ESR
Arthrocentesis 
- Cell count w/ differential
- Glucose
- Protein
- Culture
- Polarized light microscopy
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7
Q

Clear, straw-colored transudate

A

Simple joint effusion

  • Osteoarthritis
  • Degenerative meniscal injuries
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8
Q

Bloddy knee aspirate

A

Hemarthrosis

  • Ligament tear
  • Fracture
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9
Q

Hemarthrosis with fat goblets

A

Osteochondral fracture

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10
Q

Work-up for RA

A

RF

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11
Q

Side effects of NSAIDs

A

GI upset
Worsens HTN
Increases the effect of sulfonylureas

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12
Q

Can NSAIDs and ASA contribute to hepatictoxicity

A

yes

- They also contribute to coagulopathy

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13
Q

Screening for 74 year old women

A 
Colonoscopy to 75
Mammograms to 74
Depression
HTN
Lipids
- This is only if they are at risk of CAD
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14
Q

Immunization for 74 year-old

A

Tdapt: q10 yrs
Pneumococcal- > 65 gets a one time dose
Flu: Annual
Zoster: > 60

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15
Q

Knee exam

A

Inspection
Palpation
ROM
Assess tenderness and ROM of hip

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16
Q

Points of palpation

A

Patella
Tibial tubercle
All tendons
Joint lines (Anterior, Medial, and lateral)

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17
Q

Stability of the ACL only

A

Lachmann’s test

  • Flex to 30
  • Stabilize distal femur
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18
Q

Stability of ACL and PCL

A

Drawer testing

  • Flex knee to 90 degrees
  • Stabilize foot
  • Thumbs on tibial tubercle
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19
Q

Stability of MCL and LCL

Study These Flashcards
A

Valgus and Varus Stress tests

  • Do with leg in full extension and knee flexed to 30
  • Place hands on medial/lateral knee
  • Apply pressure to distal tibia
20
Q

Assess the medial and lateral menisci

  • Sens and Spec for tears
  • Positive test is pain, click, or clunk
Study These Flashcards
A

McMuray Test

  • Flex the knee as far as possible
  • Rotate tibia either internal or external
  • Bring knee to 90
  • Apply a varus or a valgus stress to knee while extending
21
Q

Tap median nerve of wrist

Study These Flashcards
A

Tinel’s sign

22
Q

Flex wrists and press dorsal surface together

Hold for 30 to 60 seconds

Study These Flashcards
A

Phalen’s test

23
Q

Anterior knee pain

Study These Flashcards
A

Patellofemoral pain syndrome

  • Overuse
  • Typical in women as “theater sign”
24
Q

Lateral knee

Study These Flashcards
A 
IT band tendonitis
- Overuse
LCL sprain
- Varus stress
- Immediate onset
Meniscal tear
- Twisting injury
- Mild effusion
- Catching and locking
25
General knee pain
``` ACL - Deceleration forces - Effusion and swelling Septic arthritis - Swelling - Turbid synovial fluid OA - Aggrevated by weight-bearing activity - Chronic stiffness - Crepitus ```
26
Medial pain
``` MCL - Misstep or collision - Swelling Meniscus -Meniscal tear - Twisting injury - Mild effusion - Catching and locking ```
27
Posterior pain
Popliteal cyst - insidious onset - Pain in the popliteal area
28
Extreme pain with any movement
Gout/Psuedogout - Clear or cloudy synovial fluid - (-) birefringent rod = gout - (+) birefringent rhomboid = pseudogout
29
Top differential for chronic knee pain
``` Sprain OA RA Gout/pesudogout Psoriatic arthritis ```
30
Subcutaneous nodules that are firm and tender Joint stiffness in morning lasting for more than 30 minutes Bilateral joint pain involving 3 or more joints
RA
31
Psoriatic plaques on extensor surface | Oligo (2 to 4) or poly (5+)
Psoriatic arthritis - Plaques are required for diagnosis - Arthritis often presents first
32
Acute monoarticular joint pain Exposure to tick bite History of rash
Lyme disease
33
HLA-B27 association | Chronic back pain and progressive loss of motion of the spine
Ankylosing spondylitis
34
Fever, skind rashes, raynauds phenomenon, pleuritis, or chest pain Butterfly rash Discoid lesions Migratory
SLE
35
When to get an x-ray for OA
Questionable diagnosis Assess severity and location No improvement with conservative therapy
36
When to get an MRI
Locking Popping Joint instability - Unless X-ray shows significant joint space narrowing
37
X-ray features of OA
Joint space narrowing Subchondral sclerosis Osteophytes Subchondral cysts
38
What corrolates the best with pain? What corrolates best with disease severity?
Patellofemoral or tibiofemoral joint osteophytes = pain | Joint space narrowing = disease progression
39
Diagnositc test of choice for carpel tunnel
Nerve conduction studies - Expensive - Often unnecessary
40
When are nerve conduction tests necessary
Symptoms do not improve with treatment Motor dysfunction Thenar atrophy
41
Most helpful findings to dx carpel tunnel
``` hand symptom diagrams - Digits 1, 2, or 3 (need 2) Hypalgesia - Decreased sensitivity to pain Weak thumb abduction ```
42
Pain management for OA
``` Exercise Acetaminophen - First line agent NSAIDs - Second line agent Intra-articular injection - Only when inflammed Acupuncture Glucosamine SAM-e Tramadol ```
43
Opiods for chronic pain
Oxycodone or morphine
44
Other options for chronic pain
TCAs Anticonvulsants - Good for neuropathic pain
45
OA pain management when conservative management fails
Tramadol Long-acting opiod with short acting for break through TCAs

Family Medicine Cases (13 decks)

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